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November 2009, Vol 99, No. S3 | American Journal of Public Health S666-S674
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.141671

RESEARCH AND PRACTICE

The Economic Cost of Environmental Factors Among North Carolina Children Living in Substandard Housing

David Chenoweth, PhD, Chris Estes, MSW, MRP and Christopher Lee, MA

David Chenoweth is with Chenoweth & Associates Inc, New Bern, NC, and the Department of Health Education and Promotion, East Carolina University, Greenville, NC. Chris Estes is with the North Carolina Housing Coalition, Raleigh. Christopher Lee is with ViQuest Inc, Greenville, NC.

Correspondence: Correspondence should be sent to David Chenoweth, PhD, FAWHP, 128 St. Andrews Circle, New Bern, NC 28562-2907 (e-mail: hmacheno{at}coastalnet.com). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We quantified the economic cost of selected environmental factors among North Carolina children living in substandard housing.

Methods. We gathered data on direct medical care costs for specific childhood medical conditions associated with environmental factors commonly found in substandard housing. Medical claims data for 2006 and 2007 were obtained from BlueCross BlueShield of North Carolina and the North Carolina Department of Health and Human Services. Indirect costs were based in part on nonmedical data obtained from several previous studies.

Results. Total (direct and indirect) costs for the conditions assessed exceeded $92 million in 2006 and $108 million in 2007. Neurobehavioral conditions contributed to more than 52% of all costs, followed by lead poisoning (20%) and respiratory conditions (12%). Neurobehavioral conditions were the largest contributor to direct medical costs (44%), followed by respiratory conditions (38%) and accidental burns and falls (10%).

Conclusions. Direct and indirect costs associated with environmental factors appear to be increasing at about twice the rate of medical inflation. More aggressive policies and funding are needed to reduce the substantial financial impact of childhood illnesses associated with substandard housing in North Carolina.






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